Exploring six successful nurse-led transition clinics: Experiences and outcomes

In the Netherlands, the 2022 Quality Standard 'Youth in transition from paediatric to adult care' underscores the importance of structured transitional care for young adults with chronic health conditions. Despite this emphasis, detailed knowledge about transition programs and their successful elements remains sparse. This study aims to bridge this gap by exploring nurse-led transition clinics that had successfully implemented core interventions such as a transition coordinator, warm handover, and individual transition plans.

Employing a mixed-methods approach, this study integrated semi-structured interviews with 15 healthcare professionals from both paediatric and adult care across six transition clinics, and surveys from 54 young adults who had transitioned within the last three years. The 'On Your Own Feet Framework' guided the evaluation of transitional care practices. Thematic analysis was applied to qualitative data, while descriptive and inferential statistics were used to analyse quantitative data.

The study revealed a strong dedication among healthcare professionals to ensuring smooth transitions and effective collaboration between paediatric and adult care. The young adults reported high satisfaction with their transitions, particularly appreciating the continuity of care and the pivotal role of nurses and nurse practitioners as transition coordinators. However, challenges such as engaging young adults, resource allocation, and financial complexities were noted, alongside areas for improvement including shared decision-making and managing parental involvement. Motivation and collaboration among staff were identified as facilitating factors.

Our findings emphasize the vital role of nurse-led transition clinics in enhancing healthcare transitions for young adults in the Netherlands, aligning with the principles outlined in the Quality Standard and the On Your Own Feet Framework. While high satisfaction levels with current practices suggest a positive impact, they also highlight that ongoing improvement and adaptation are needed to overcome identified challenges. Successful healthcare transition requires a comprehensive, collaborative approach involving patients, families, and healthcare professionals, supported by organizational and systemic frameworks. This study contributes to a nuanced understanding of transitional care, suggesting a path forward for integrating these practices into standard care models.